New stats show Vermont mental health patients waiting for treatment

By MIKE FAHER VtDigger

Saturday, February 16, 2019

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As Vermont officials seek ways to bolster an overburdened mental health system, new statistics are shedding light on the size of that problem.

A legislative report shows that there were more than 5,000 admissions for inpatient psychiatric care in Vermont during federal fiscal year 2018. Over the same period, there were 10,100 discharges of mental health patients from emergency departments — a rate of nearly 28 per day.

The report also says mental health patients waited, on average, almost a full day in emergency rooms before they could get into a psychiatric unit or were discharged. That underscores the dilemma of Vermonters who need mental health treatment but can’t immediately access it.

“I think the sheer volume and the emergency department wait times illustrate the stress our hospitals are under in trying to provide compassionate care for people who are in a mental health crisis,” said Devon Green, government relations vice president for the Vermont Association of Hospitals and Health Systems.

The stress on Vermont’s mental health system has most recently manifested in several hospitals facing regulatory violations for mistreatment of psychiatric patients. Issues have included improper use of law enforcement and restraints, incidents of assault and injury, escapes and a lack of adequate staffing and training.

One factor behind those problems is a shortage of inpatient psychiatric beds. There’s a push to expand to build more beds, but that will take time, and current plans may not meet the state’s projected need.

The new statistics from the Department of Mental Health — compiled in response to a legislative request for more data — provide more insight into why psychiatric units and emergency rooms are struggling to keep up with demand.

The statistics also provide more clarity because they include those who have sought voluntary treatment — not just involuntary patients who are in custody of the state. Green said it’s been about a decade since similar statistics were compiled.

“Access to this data and information is essential for us to make sound policy decisions and meaningful progress on improving care for mental health patients,” she said.

The report’s findings include:

■From October 2017 though September 2018, there were 5,064 adult admissions for inpatient psychiatric treatment in Vermont. The vast majority of those patients — 4,603 — were admitted voluntarily.

■The average length of inpatient stay for a voluntary psychiatric patient was 17 days. But patients receiving involuntary treatment stayed much longer — an average of 46 days.

■There were 344 inpatient hospitalizations of children at the Brattleboro Retreat in federal fiscal year 2018. The average stay was 13.5 days — significantly less than adult inpatient stay lengths in the state.

■Of the 10,100 emergency room discharges for mental health patients, 8,514 were admitted to a psychiatric unit of a different hospital or were discharged into the community. The remainder went to a psychiatric unit at the same hospital where they had received emergency treatment.

■Emergency room wait times for mental health patients lasted an average of 0.9 days. But involuntary patients waited longer — an average of 2.1 days or 3.4 days, depending on the next stage of their treatment.

During legislative testimony on Tuesday before the Senate Health and Welfare Committee, there were no firm policy proposals based on the new data.

But officials said one big takeaway was the large number of patients voluntarily seeking treatment. Nearly 91 percent of inpatient admissions were voluntary, as were more than 94 percent of psychiatric patients discharged from emergency rooms.

“We thought that volume was very surprising,” said Emma Harrigan, policy analysis and development director for the hospital association.

State Mental Health Commissioner Sarah Squirrell said the statistics reinforce the need to focus on community based services for those in need of psychiatric care. Squirrell noted that there were only about half as many inpatient admissions as there were emergency room discharges for mental health patients.

“That would indicate that about 50 percent of people are going back into the community,” Squirrell said. “So when we look at that data, it causes us to think about how important those community level, step-down supports are.”

The number of mental health patients seeking treatment in emergency rooms also caught Squirrell’s attention.

“Is the emergency room perceived to be the only door to receive that kind of support and treatment?” Squirrell said. “And what opportunities do we have to strengthen the knowledge ... to access resources at the community level before going through the emergency room door?”

The report also offered a look at the contentious issue of restraint use on mental health patients in emergency rooms. The hospital association says there were 290 instances of restraint use from December 2017 through November 2018.

That’s not the same time period as the rest of the report’s data. But officials pointed out that incidences of restraint amount to about 2 percent of the emergency room use for psychiatric patients in fiscal 2018.

Sen. Ginny Lyons, D-Chittenden and chair of Senate Health and Welfare, said Tuesday’s presentation was the beginning of a larger discussion about mental health issues.

“There are 1,000 questions embedded in the data that you have,” Lyons said.